Provider Demographics
NPI:1487039103
Name:JOHNSON CITY ACUPUNCTURE AND HERBS LLC
Entity Type:Organization
Organization Name:JOHNSON CITY ACUPUNCTURE AND HERBS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER, LAC
Authorized Official - Prefix:
Authorized Official - First Name:SUMALEE
Authorized Official - Middle Name:T
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-544-1806
Mailing Address - Street 1:1093 WILLOW SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-3224
Mailing Address - Country:US
Mailing Address - Phone:423-544-1806
Mailing Address - Fax:
Practice Address - Street 1:206 PRINCETON RD STE 31B
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-2025
Practice Address - Country:US
Practice Address - Phone:423-544-1806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNACU166302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization